All residents of Greene County should be vaccinated, health department says.

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SPREADING SOUTH: The first case of Hepatitis A was reported in Clay County; the source was from Missouri. The Arkansas Department of Health has been proactive, vaccinating 13,000 residents in Northeast Arkansas and reaching out to more.

As of last Thursday, the number of Arkansans in Northeast Arkansas infected with the liver-attacking Hepatitis A virus reached 91, and the state Department of Health says there is no sign the rate is slacking off.

The virus, this one unusually virulent, was first reported in February in Clay County, and has now spread south to contiguous counties. Ninety percent of the cases have come from Greene County in the past two months, and persons in Lawrence, Randolph and Craighead counties have been diagnosed. All but one of the 91 are adults. One person has died.

The health department has so far provided vaccines to 13,000 people, has enough in stock for 10,000 more, and can resupply, Dr. Dirk Haselow, the state epidemiologist, said. Because of the high rate there, the health department is recommending that all people in Greene County between the ages of 19 and 60 be vaccinated; 8,000 have so far.

The strain of Hepatitis A virus now infecting people across the country is unusual, coming from North Africa and the Middle East, Haselow said. It is more potent: Hepatitis A infections usually require hospitalization in only one in 10 cases, but the strain in the U.S. is requiring hospitalization in five out of 10 cases, and the fatality rate is 10 times higher than normal. Hand sanitizer that is 70 percent alcohol has been shown to be ineffective in killing the virus.

Hepatitis A is spread through fecal contamination, most commonly from restaurant workers who have not washed their hands before serving food. But in Arkansas, Haselow said, only eight food workers have been identified as infected. He said that most of the cases the department is seeing are people with compromised immune systems and chronic disease, people living in close contact with others in shelters, jail or on the streets, and people who use drugs. Haselow said the drug use does not have to be intravenous: Sharing a marijuana cigarette with someone whose hands aren't clean can be a source of transmission.

The infection in Arkansas apparently comes from Butler County, Mo., where there was an outbreak in a community where the homeless and drug-using population was high, Haselow said.

There has been a "herculean effort" on the part of the health department to slow the spread of the virus, the epidemiologist said. The department has people on the ground interviewing persons who've come in social or sexual contact with known cases — Haselow estimated that could be up to a thousand people — and has set up temporary vaccination clinics in Paragould and Piggott (Greene County), Corning (Clay County), Jonesboro (Craighead County) and Walnut Ridge (Lawrence County). Employees are also reaching out to homeless shelters, drug treatment centers, prisons, restaurants and faith-based organizations "to identify and get inroads into the vulnerable population who might otherwise feel stigmatized," Haselow said.

Haselow said the vaccine has been offered to all restaurants where an employee has contracted the virus. Two-thirds of them accepted, he said.

The department sent out notices to communities about restaurants where an employee had been shown to be infected, including a Subway and a Taco Bell in Corning, a Little Caesar's Pizza and the Ironhorse Barbeque in Paragould, a gas station in Walnut Ridge, a Steak 'n' Shake in Jonesboro and a Red Lobster in Fort Smith. (The Fort Smith case was unrelated to the Northeast Arkansas cases, the department says, because the infection originated out of the country.)

Because the vaccine is so effective — with a cure rate of 94 percent after a single dose and 99 percent after two — virus-associated restaurants who've vaccinated their workers are probably safer than nonassociated restaurants, Haselow said.

The virus takes from three to six weeks to cause symptoms, which makes it difficult to track to a particular eating establishment, Haselow said. Symptoms include nausea, vomiting, diarrhea, fever, jaundice and abdominal pain. Unlike Hepatitis B and C, however, Hep A is not chronic: The vaccine can wipe it out.

People between the ages of 19 and 60 are most vulnerable, Haselow said, because those younger than 19 have been vaccinated as a matter of course and those older than 60 have probably been exposed and are therefore immune. The older population was exposed because the food supply was local when they were children and not as regulated as the huge global food suppliers of today are.

"While generally food safety has improved, he said, because the suppliers are bigger, "when there's a screwup, there's a big screwup." He cited a fast outbreak in Mexico of 700 cases after onions that had been fertilized with human waste were delivered to a restaurant.

Because the number of new cases — five or six a week — is increasing slowly, Haselow said he could not predict when the spread of infection will stop. The outbreak so far is not the worst Arkansas has experienced: In 1990, between 600 and 700 cases were reported. Since then, Haselow said, 10 cases or fewer a year have been reported.

Ten states are reporting Hepatitis A outbreaks. The outbreak has been most serious in Kentucky, where the outbreak is statewide and 1,170 cases and eight deaths were reported as of late July.

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